Day One

So here I am. the ER. The ER and I. It's been six weeks since I've talked to a patient, 10 weeks since I've been invested in a patient's care (and that was a psych rotation), 5 months since I've really touched a patient, and over a year since I've been expected to manage a patient. In other words, it's been a damn long time since I've felt like a doctor, or even a student doctor.

I've been told that rotation through the Hospital X (HX) ER* will cure even the most reluctant medical student. There is no shallow end there, it's all deep. It is a "kick you out of the nest, watch you hit the ground, then roll you to a cliff and push you off again" sort of rotation. Fly dammit, now.

The anticipation - horrible. I've been fretting about this rotation since I signed up for it. And the fretting became physical about a week ago. . culminating with my last 2 days of "freedom" being spent mourning the fast encroching loss of my freedom and worrying about how may days into the rotation I will be kicked out of medical school for my lack of knowledge, skill, and all-round un-doctorlyness. Needless to say, I was spinning a wee bit the night before. For example, at 10:00 at night I decided it would be a great idea to make not some not-so-important cheat sheets I've been meaning to make for a year. It shouldn't be a surprise to anyone that I did not sleep so hot that night.

The introductory lecture of the rotation only added to my anxiety. I thought the rotation director would be gentle and smiley and welcome us to HX with big hugs and words of reassurance. Instead she was more than a little manic (tip to SR) and spoke so fast that I'm still not really sure of about half of what she said. I left the room even more wide-eyed and petrified. I ran through the list of probable alternative jobs in my head: teacher, sign language interpreter, singer, farmer, lab rat, dog trainer, whale tank cleaner, balloon animal maker .. . really, anything. ANYTHING would have been less stressful than this, I thought. What the F was I thinking? If I could go back to that 23 year old and talk to her, I would shake her. . . a lot. . and say you stupid, naive girl. Stress. . .it sucks, I promise you that by 29, you will realize it's not even close to what it's cut out to be. That's what I was thinking as I speed walked across the street to the ED, trying desperately to keep up with the clerkship director who apparently also walks manically.

So day 1 started, and day 1 continued, and then day 1 ended and I didn't die OR cry once. (Of course with 17 days left, there is plenty of time left for that).

The ED Green (where the less acute patients are seen - think urgent care) has a fast pace and you tick away your time there by patients rather than hours. We work "12 hour" shifts, but they end up being more than that since you have to tack time on for the patients that are essentially ready to go, but not out the door, when your shift ends. The responsible doctor and med student doesn't just hand those patients off to his/her replacement. . nope, he/she finishes what he/she started. You discharge those patients, and that's a lot of paperwork and a bit of time. Plus you have to finish any and all charts that you might not have had time to complete during the day. This took me 2 extra hours my first day. . .I'm hoping I can trim that time down a bit.

Somehow, in an ED that sees few to no pelvic exams, I ended up doing 2 today. This morning during our tour, we walked by the pelvic exam room and the clerkship director pointed at the room and said. . "There's the pelvic exam room, but you probably won't ever see it. We really don't do pelvics here." (On a side note, I found this statement rather odd. . really, any woman coming into the ED with abdominal pain and/or vaginal bleeding should probably get a pelvic exam). But despite that statement, it was like the Gods of irony and the Gods of Gentle Introductions to Scary Rotations were holding hands and blessing me today. Female problems and pelvic exams are a homecoming from me. I'm not saying I was perfect, but at least I can understand the gynecological language.

The high point of the day was the young female (from jail) who presented with abdominal pain and thought she was 3 months pregnant. Her uterus was just too big for her reported gestational age so I thought, she has to be further along. Turns out we were both right. A quick bedside ultrasound showed us a head, an arm, a leg, a heart. . then we moved the ultra sound probe and saw the heart again. . but then we also saw a different heart. . and then the first heart. . and then the 2 hearts side -by-side. Twins, with a gestational age of about 4 months! An exciting moment for the ED.

And the look of surprise, fear, and joy on the girl's face was, well, heart warming and heart wrenching. She flashed the first smile I'd seen on her face all day.

*In order to keep these posts somewhat confidential, I will be changing identifying characteristics of patients, including the name of the hospital, which I have changed to Hospital X, or HX for short.